Chahrour Mohamad A, Habib Joseph R, El Moheb Mohamad N, Cherfan Patrick, Mahmoud Dima, El Rahyel Ahmed, Khachfe Hussein, Hoballah Jamal J
Division of Vascular and Endovascular Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Scholars in Health Research Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
Ann Vasc Surg. 2022 Apr;81:343-350. doi: 10.1016/j.avsg.2021.09.040. Epub 2021 Nov 12.
Surgical site infections (SSIs) following lower extremity amputations (LEAs) are a major cause of patient morbidity and mortality. The objectives of this study are to investigate the annual incidence of SSI and risk factors associated with SSI after LEA in diabetic patients.
LEAs performed on diabetic patients between 2005 and 2017 were retrospectively analyzed from the American College of Surgeons National Surgical Quality Improvement Program database. Incidence rates were calculated and analyzed for temporal change. Multivariable logistic regression was conducted to identify the independent predictors of SSIs in LEA.
In 21,449 diabetic patients, the incidence of SSIs was 6.8% after LEA, with an overall decreasing annual trend (P = 0.013). Amputation location (below-knee in reference to above-knee) [OR (95% CI): 1.35 (1.20 - 1.53), P <0.001], smoking [OR (95% CI): 1.25 (1.11 - 1.41), P <0.001)], female sex [OR (95% CI): 1.16 (1.03 - 1.30)], preoperative sepsis [OR (95% CI): 1.24 (1.10 - 1.40), P <0.001], P = 0.013], emergency status [OR (95% CI): 1.38 (1.17 - 1.63), P <0.001], and obesity [OR (95% CI): 1.59 (1.12 - 2.27), P = 0.009] emerged as independent predictors of SSIs, while moderate/severe anemia emerged as a risk-adjusted protective factor [OR (95% CI): 0.75 (0.62 - 0.91), P = 0.003]. Sensitivity analysis found that moderate/severe anemia, not body mass index (BMI) class, remained a significant risk factor in the development of SSIs in below-the-knee amputations; in contrast, higher BMI, not preoperative hematocrit, was significantly associated with an increased risk for SSI in above-the-knee amputations.
The incidence of SSIs after LEA in diabetic patients is decreasing. Overall, below-knee amputation, smoking, emergency status, and preoperative sepsis appeared to be associated with SSIs. Obesity increased SSIs in above-the-knee amputations, while moderate/severe preoperative anemia appears to protect against below-the-knee SSIs. Surgeons should take predictors of SSI into consideration while optimizing care for their patients, and future studies should investigate the role of preoperative hematocrit correction and how it may influence outcomes positively or negatively.
下肢截肢（LEA）术后手术部位感染（SSI）是患者发病和死亡的主要原因。本研究的目的是调查糖尿病患者LEA术后SSI的年发病率及相关危险因素。
从美国外科医师学会国家外科质量改进计划数据库中回顾性分析2005年至2017年期间对糖尿病患者实施的LEA。计算发病率并分析其随时间的变化。进行多变量逻辑回归以确定LEA中SSI的独立预测因素。
在21449例糖尿病患者中，LEA术后SSI的发病率为6.8%，总体呈逐年下降趋势（P = 0.013）。截肢部位（以膝下截肢相对于膝上截肢为参照）[比值比（95%可信区间）：1.35（1.20 - 1.53），P <0.001]、吸烟[比值比（95%可信区间）：1.25（1.11 - 1.41），P <0.001]、女性[比值比（95%可信区间）：1.16（1.03 - 1.30）]、术前脓毒症[比值比（95%可信区间）：1.24（1.10 - 1.40），P <0.001]、急诊状态[比值比（95%可信区间）：1.38（1.17 - 1.63），P <0.001]和肥胖[比值比（95%可信区间）：1.59（1.12 - 2.27），P = 0.009]是SSI的独立预测因素，而中度/重度贫血是风险调整后的保护因素[比值比（95%可信区间）：0.75（0.62 - 0.91），P = 0.003]。敏感性分析发现，在膝下截肢中导致SSI发生的显著危险因素是中度/重度贫血，而非体重指数（BMI）类别；相反，在膝上截肢中，较高的BMI而非术前血细胞比容与SSI风险增加显著相关。
糖尿病患者LEA术后SSI的发病率正在下降。总体而言，膝下截肢、吸烟、急诊状态和术前脓毒症似乎与SSI相关。肥胖会增加膝上截肢术后的SSI，而术前中度/重度贫血似乎可预防膝下截肢术后的SSI。外科医生在优化患者护理时应考虑SSI的预测因素，未来的研究应调查术前血细胞比容纠正的作用以及它可能对结果产生的正面或负面影响。
